MASSACHUSETTS ALL-PURPOSE ACKNOWLEDGMENT Gov. …

[Pages:2]MASSACHUSETTS ALL-PURPOSE ACKNOWLEDGMENT Gov. Exec. Ord. #455(03-13), ?5(d)

} Commonwealth of Massachusetts ss. County of _____________________________________

On this the ______________ day of ______________________________, __________________, before me,

Day

Month

Year

_______________________________________________, the undersigned Notary Public, personally appeared Name of Notary Public

_______________________________________________________________________, proved to me through Name(s) of Signer(s)

satisfactory evidence of identification, which was/were __________________________________________ Description of Evidence of Identity

_____________________________________________________, to be the person(s) whose name(s) is/are signed on the preceding or attached document, and acknowledged to me that he/she/they signed it voluntarily for its stated purpose(.)

as partner(s) for ______________________________________ Name of Partnership

_______________________________________, a partnership.

as __________________________________________________ for

Title of Office ____________________________________________, a corporation.

Name of Corporation as attorney in fact for _________________________________

Name of Principal Signer _____________________________________________, the principal.

as _________________________________ for _________________ Type of Capacity

_________________________________, a/the ___________________.

Name of Person/Entity

Type of Entity

________________________________________________________ Signature of Notary Public

_______________________________________________________ Printed Name of Notary

Place Notary Seal and/or Stamp Above My Commission Expires: _________________________________

OPTIONAL Though this section is optional, completing this information can deter alteration or fraudulent

reattachment of this form to an unintended document. Description of Attached Document

Title or Type of Document: _________________________________ Document Date: __________________________

Number of Pages: ___________ Signer(s) Other Than Named Above: _________________________________

? 2013 National Notary Association ? ? 1-800-US NOTARY (1-800-876-6827) Item #5951

Massachusetts All-Purpose Acknowledgment

The All-Purpose Acknowledgment certificate is used when an individual is signing and acknowledging either on his or her own behalf, or as a representative on behalf of another person or legal entity such as a corporation.

The optional section at the bottom can deter alteration of

the document or fraudulent reattachment of this form to an unintended document. The insertions in this section are not required by law. Failure to fill out this section will not affect the validity of the certificate.

Instructions:

1 NAME OF COUNTY where Notary

7 SIGNATURE OF NOTARY, exactly

performs notarization.

as name appears on commissioning

2 DATE OF NOTARIZATION. Actual

paper and in seal.

day, month and year in which signer appears before Notary.

3 NAME OF NOTARY, printed exactly as name appears on commissioning paper, on seal and in signature.

4 NAME(S) OF SIGNER(S) appearing before Notary. Initials and spelling should agree with name(s) signed on document and ID card signatures. Adapt "person(s)," "name(s)," "is/are" and "he/she/they," below, to number of signer(s) named here.

5 HOW SIGNER(S) WAS/WERE IDENTIFIED. Describe type of satisfactory evidence of identity relied on, such as "Personal knowledge of identity," or "Massachusetts driver's license," or "Personally known credible identifying witness." Adapt "was/were" depending on whether one or more type of evidence described.

MASSACHUSETTS ALL-PURPOSE ACKNOWLEDGMENT Gov. Exec. Ord. #455(03-13), ?5(d)

1 } Commonwealth of Massachusetts

County of ____________N__o_r_f__o__lk_________________

ss.

2 On this the _______1_4_t__h___ day of _________F__e_b__r_u_a__r_y___________, _____2__0__13_________, before me,

Day

Month

Year

3 ______________P_a__t___R__.__J__o_n__e__s________________, the undersigned Notary Public, personally appeared

Name of Notary Public

4

___________M__a__r_y___T_. __R_i_c__h_a_r__d_s________________________________________, proved to me through

5 satisfactory

evidence

of

Name/(s) of Signe/r(s)

identification, which was/were

____________M__a__s_s__a_c__h_u__s_e__t_t_s____________

_____D_r_i_v__e_r_'_s___L_i_c_e__n_s__e_____________________________, to

signed on the preceding or attached document,

Description of Evidence of Identity

/ / be the person(s) whose name(s)

and acknowledged to me

is/are that

he/she/they signed it voluntarily for its stated purpose(.)

A

as partner(s) for ______________________________________ Name of Partnership

6

_______________________________________, a partnership.

as __________________________________________________ for

B Title of Office ____________________________________________, a corporation.

Name of Corporation

as attorney in fact for _________________________________

C Name of Principal Signer _____________________________________________, the principal.

10

D

PAT R. JONES Norfolk County Notary Public ? Massachusetts My Commission Expires May 25, 2016

Place Notary Seal and/or Stamp Above

as _________________________________ for _________________ Type of Capacity

_________________________________, a/the ___________________.

Name of Person/Entity

Type of Entity

7 ________________________________________________________ Signature of Notary Public

8 _______________________P_a_t___R__. __J_o__n_e__s_________________ 9 Printed Name of Notary

My Commission Expires: ________M__a_y___2_5__, _2__0_1_6___________

OPTIONAL

Though this section is optional, completing this information can deter alteration or fraudulent reattachment of this form to an unintended document.

11 12 Description of Attached Document

Title or Type of Document: __G__r_a__n__t___D_e__e_d_________________ Document Date: ___2__/_1_4_/_1_3________________

14 Number of Pages: __o__n_e______ Signer(s) Other Than Named Above: _N__o___O__t_h__e_r___S__ig__n__e_r_s__________ 13 ? 2013 National Notary Association ? ? 1-800-US NOTARY (1-800-876-6827) Item #5951

8 PRINTED NAME OF NOTARY, exactly as name appears on commissioning paper and in seal.

9 NOTARY'S COMMISSION EXPIRATION DATE, exactly as it appears on commissioning paper.

10 NOTARY SEAL IMPRINT, clearly and legibly affixed.

SPACES 11?14 ARE OPTIONAL. Omission of information here will not affect the document's validity. However, completing these spaces can deter alteration of the document or fraudulent reattachment of this form to an unintended document.

11 TITLE OR TYPE OF DOCUMENT. The type, title or description of the document being notarized, such as "Grant Deed."

12 DATE OF DOCUMENT notarized.

6 REPRESENTATIVE CAPACITY If signer is not acting on his or her own behalf as an individual, one of the following four boxes must be checked and

Most but not all documents will have a date, usually at the top of the page or following the signature. If none, insert "No Date."

the respective blank space(s) filled in:

13 NUMBER OF PAGES in the notarized document. This may point out

A PARTNERSHIP. If signer(s) is/are acknowledging as partner(s) of partnership, check top box and write in name of partnership.

fraudulent addition or removal of pages. Do not count the certificate as a page. However, the certificate will be regarded as a page by recording officials in assessing recording fees.

B CORPORATION. If signer is acknowledging as officer of a corporation, check second box, write in corporate title of signer and name of corporation.

14 SIGNER(S) OTHER THAN NAMED IN SPACE 4. Since some signers might not be named on the same notarial certificate, insert name(s) of other signer(s) here that appear(s) or will appear on other certificates --

C ATTORNEY IN FACT. If signer is acknowledging as attorney in

as many as space allows. If none, insert "No Other Signers."

fact, check third box and write in name of absent principal signer.

D OTHER. If signer is acknowledging in capacity not listed above, check bottom box and write in type of capacity (i.e., director, trustee, legal guardian, etc.) name of person or entity represented, and type of entity (i.e., minor child, trust, etc.).

National Notary Association

9350 De Soto Avenue ? Chatsworth, CA 91311-4926 ? 1-800-876-6827 ?

? 2013 National Notary Association

Item #5951

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